Healthcare Provider Details

I. General information

NPI: 1710467600
Provider Name (Legal Business Name): JANE L OSBORNE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N MAIN ST
SAN ANGELO TX
76903-4077
US

IV. Provider business mailing address

902 N MAIN ST
SAN ANGELO TX
76903-4077
US

V. Phone/Fax

Practice location:
  • Phone: 325-655-7391
  • Fax: 325-655-1413
Mailing address:
  • Phone: 325-655-7391
  • Fax: 325-655-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number113292
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: